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General NPI Number Information
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NPI Number | 1568855278
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Entity Type | Organization
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Legal Business Name | REMEMBER WHEN ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 5729 NW 82ND ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73132-4909
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Country | US
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Telephone | 405-603-4143
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Fax | 405-603-4345
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Provider Business Mailing Address
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Address Line | 5729 NW 82ND ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73132-4909
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Country | US
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Telephone | 405-603-4143
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Fax | 405-603-4345
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PENNY R BALLARD
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Credential |
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Telephone | 405-812-3966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL5540-5540
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License Number State | OK
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